The request sought correspondence and oversight documents regarding private-practice imaging sessions at Manx Care from 2021 to present, but the authority provided a 2021 annual radiation safety report covering the period 2019-2021 instead, with part of the information exempt.
Key Facts
The response includes an IRS Annual Report for Nobles Hospital covering the period 1st June 2019 to 31st May 2021.
In 2020, the statutory 2 mSv dose investigation level for whole body exposure was exceeded by a Nuclear Medicine staff member.
Extremity dose investigation levels were exceeded in both 2019 and 2020 for Nuclear Medicine staff.
Unusually high doses in Radiology in 2019 were attributed to cargo x-ray machines scanning packages despite x-ray sensitive labels.
Dose sharing cooperation exists between Manx Care and Manx Medical Limited (MML) for employees working at both sites.
Data Disclosed
20 mSv
500 mSv
1.42 mSv
2.24 mSv
58 mSv
64 mSv
1.69 mSv
1.21 mSv
4.02 mSv
0.36 mSv
0.4 mSv
1st June 2019
31st May 2021
Wednesday 6th October 2021
2019
2020
2016
2017
2018
174
132.8
120.89
136.82
83.56
Original Request
Dear FOI Officer,
To narrow the focus of my request, please treat this as a refined FOI request solely concerning private-practice imaging sessions undertaken within Manx Care facilities from 1 January 2021 to present.
Scope of Request
1. All correspondence (email, memos, meeting minutes) between:
o The Radiation Protection Adviser (RPA) or Radiation Protection Supervisor (RPS)
o Any member of the Executive Team or Radiology Department relating exclusively to the scheduling, approval, governance or oversight of private-practice sessions.
2. Any internal reports, risk assessments or policy documents authored by the RPA/RPS (or reviewed by the Executive Team) that address:
o Justification and optimization of private-practice patient exposures under Isle of Man (IOM) Ionizing Radiation (Medical Exposure) Regulations 2019 (IR(ME)R19).
o Staff dose monitoring, safety concerns or conflict-of-interest issues arising from private-practice work under IIRAO19.
o Equipment allocation, maintenance or quality assurance specifically for private-practice sessions.
3. Copies of any local rules, standard operating procedures or contracts governing private-practice use of the following modalities:
o CT (all CT scanners)
o Fluoroscopy & interventional suites
o Digital X-ray rooms
o MRI (all scanners)
o Ultrasound rooms
Data Tables (225)
REPORT OF THE WORK OF
INTEGRATED RADIOLOGICAL SERVICES LIMITED
FOR
Nobles Hospital – Isle of Man
Reporting Period 1st June 2019 to 31st May 2021
Name
FINGER
Hp 0.07
(mSv)
2016
FINGER
Hp 0.07
(mSv)
2017
FINGER
Hp 0.07
(mSv)
2018
FINGER
Hp 0.07
(mSv)
2019
FINGER
Hp 0.07
(mSv)
2020
80.8
58
53.2
57.89
64.16
12.7
12.6
13.14
8.78
4.71
60.6
47.6
50.45
25.27
9.91
19.9
14.6
4.1
0.42
4.78
Total
174
132.8
120.89
136.82
83.56
RPA/MPE AND SURVEY WORK UNDERTAKEN FOR NOBLES
HOSPITAL FROM 1st June 2019 to 31st May 2021
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles Jobs (88)
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles Jobs (88)
RPA20-2845
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles Jobs (88)
RPA21-1448
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles Jobs (88)
RPA20-2536
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles Jobs (88)
RPA19-6510
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles Jobs (88)
RPA19-3302
RPA WORK COMPLETED ( 97 )
Job Card Date In Date Out Task Code Contact Type Contact Name
Ref
Nobles NM Jobs (8)
RPA20-6384
SURVEY WORK COMPLETED ( 65 )
Schedule Report Date Survey Ref Survey Location Details Equipment Details
Ref Date
Nobles Surveys (55)
REPORT OF THE WORK OF
INTEGRATED RADIOLOGICAL SERVICES LIMITED
FOR
Nobles Hospital – Isle of Man
Reporting Period 1st June 2021 to 31st May 2022
Name
FINGER
FINGER
FINGER
FINGER
FINGER
Hp 0.07
Hp 0.07
Hp 0.07
Hp 0.07
Hp 0.07
(mSv)
(mSv)
(mSv)
(mSv)
(mSv)
2017
2018
2019
2020
2021
58 53.2 57.89 64.16 102
12.6 13.14 8.78 4.71 2.63
47.6 50.45 25.27 9.91 12.02
14.6 4.1 0.42 4.78 1.04
Total 132.8 120.89 136.82 83.56 117.69
Wearer
Nobles WB Dose
(mSv)
MPC WB Dose
Total Whole Body
Dose (mSv)
(mSv)
0.00 1.31 1.31
Radiographer <0.3 0.00 <0.3
Nurse <0.3 0.00 <0.3
Nobles WB Dose
(mSv)
Total Whole Body
Dose (mSv)
RPA Job No.
Date
Incident Summary
Summary of IRS advice
issued
Patient A attended ED and was x- Accidental dose is about
rayed. Returned the following day for 0.68µSv. The additional lifetime
a review, no further x-rays were cancer risk is roughly 1 in 26
required. million and is considered
Patient B attended ED and was negligible.
RPA22-2699 30/03/2022
triaged with a request made for
scaphoid views. Considered reportable to the
Patient A was taken from ED to x-ray enforcement authority.
and had the scaphoid images taken Investigation recommended.
under Patient B’s demographics.
RPA22-0408
19/01/2022
An administrative error in referring a
patient for a CT scan lead to the
wrong patient being scanned.
Accidental dose is about
13.7mSv. The additional lifetime
cancer risk is roughly 1 in 6,000
and is considered low risk.
Considered reportable to the
enforcement authority.
Investigation recommended
Accidental dose is about 1.2mSv.
The additional lifetime cancer risk
is roughly 1 in 83,000 and is
Wrong wristband on patient which considered very low risk.
RPA21-4296 18/06/2021
lead to the accidental exposure
Considered reportable to the
enforcement authority.
Investigation recommended
Breast Clinic Ultrasound - BU22-2637 Equipment Age
GE Logiq S8 A plan should be considered for replacement
of this equipment
Mammography Mammo
Reporting Monitors
ID22-2638
Luminance Response
Monitors need to be recalibrated so that the
maximum luminance between the left and right
monitors is within 5% (and >450cd/m2)
Mammography – Room 2 MM22-2641 Image Quality – Detail Detection
It is recommended that the mammography
radiologists be consulted over image quality,
with the option to further improve image
quality by switching to the ‘High Dose’ setting,
if they deem it will aid clinical diagnosis. It
should be noted that this ‘high dose’ setting
gives doses much lower doses than national
tolerance levels, and at levels more
comparable to digital mammography
systems from other manufacturers
Mammography – Room 2
MM22-2641
Image Quality – CDMAM (Tomosynthesis
Mode)
It is recommended image quality be
undertaken locally and compared to (a)
reference baseline
image(s). IRS have also undertaken image
quality checks ‘TORMAX’ and ‘TORMAM’ test
objects.
Results are provided for reference.
Mammography – Room 1 MM22-2642 Image Quality – Detail Detection
It is recommended that the mammography
radiologists be consulted over image quality,
with the option to further improve image
quality by switching to the ‘High Dose’ setting,
if they deem it will aid clinical diagnosis. It
should be noted that this ‘high dose’ setting
gives doses much lower doses than national
tolerance levels, and at levels more
comparable to digital mammography
systems from other manufacturers
Ultrasound - GE Logiq S8 U23-1636 ML6-15-D: transducer should only be
considered for clinical use when high
penetration is not required
CT – Mediso AnyScan CT23-1643 The CT numbers of LDPE and PTFE should be
investigated during next routine service
Ultrasound – GE Logiq E10 U23-1651 A label with the date of the last checks should
be updated and left either on the scanner or in
the QA log book for future reference
DEL Medical FMT18T X23-1850 LBD – The maximum size of the LBD
(Ramsay) exceeded the maximum detector size by >3cm
X23-1850 The exposure switch should be labelled
properly so it is clear which is for the OPG
and which is for the x-ray tube.
REPORT OF THE WORK OF
INTEGRATED RADIOLOGICAL SERVICES LIMITED
FOR
Nobles Hospital – Isle of Man
Reporting Period 1st June 2023 to 31st May 2024
Name
2023 Dose (mSv)
0.3
0.23
0.19
0.14
0.11
C-arm
Badge Location
2023 Dose
No.
(mSv)
1
II 1 BASE,10096
0.09
1
II 1 DETECTOR,10098
5.81
1
II 1 TUBE,10097
5.58
2
II 2 BASE,10099
1.3
2
II 2 DETECTOR,10100
0.42
2
II 2 TUBE,10101
24.36
3
II 3 MINI C-ARM,10102
M
Wearer
Nobles WB Dose
(mSv)
MPC WB Dose
Total Whole Body
Dose (mSv)
(mSv)
0.00 0.42 0.42
Radiographer <0.2 0.00 <0.2
Nurse Not Known 0.00 -
Nobles WB Dose
(mSv)
Total Whole Body
Dose (mSv)
Number
Required Action
Owner
Completion
Date
1.
Review and up-date risk assessments to the
same format as the CT V2
RPS
2.
Provide an SOP for testing and QA of lead
rubber garments.
RPS
3.
Undertake environmental monitoring of main radiology.
(please provide a floor layout drawing of all rooms for
advice on monitoring positions).
RPS
RPS Refresher Training
24/07/2024
Laser Safety Training Course
06/08/2024
CBCT Level 1 - Core Training
06/11/2024
RPS Refresher Course
04/12/2024
EQUIPMENT SURVEY RECOMMENDATIONS FOR NOBLES
HOSPITAL FROM 1st June 2023 to 31st May 2024
Equipment
Survey ID
Recommendation
Ultrasound - GE Logiq S8 U23-1636 ML6-15-D: transducer should only be
considered for clinical use when high
penetration is not required
CT – Mediso AnyScan CT23-1643 The CT numbers of LDPE and PTFE should be
investigated during next routine service
Ultrasound – GE Logiq E10 U23-1651 A label with the date of the last checks should
be updated and left either on the scanner or in
the QA log book for future reference
DEL Medical FMT18T X23-1850 LBD – The maximum size of the LBD
(Ramsay) exceeded the maximum detector size by >3cm
X23-1850 The exposure switch should be labelled
properly so it is clear which is for the OPG
and which is for the x-ray tube.
From:
To:
Cc:
Subject: Private Patients - Process Change Update
Date: 11 March 2025 12:41:34
Attachments: image001.png
image004.png
image005.png
image003.png
image008.png
image009.png
image010.png
image011.png
image014.png
image018.png
image019.png
Good afternoon All,
We have a patient registration form that needs to be completed by the patient prior to PPU scheduling Radiology exams now (this is for
all Private Treatment), in the interim this will slow down the process of scheduling as we need to wait for the form to be returned then
register the patient in our system to confirm insurance information is correct.
We have emailed approximately 20-30 registration forms over the last 2 days so we are waiting for these to be returned.
Please note the reason for the change in process is to provide a legally binding agreement between PPU and the patient and financial
reasons regarding approval of insurance membership information.
Kind regards,
3
Reayrt Noa • Noble’s Hospital • Strang
Braddan • Isle of Man • IM4 4RJ
• www.manxcare.im
From:
Sent: 07 March 2025 09:19
To:
Cc:
Subject: Radiographer Private Patient Availability 10/03 - 16/03
Good morning All,
Can we please have availability for next week?
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Date 10-Mar 11-Mar 12-Mar 13-Mar 14-Mar 15-Mar 16-Mar
AM
PM
Kind regards,
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
10-Mar
11-Mar
12-Mar
13-Mar
14-Mar
15-Mar
16-Mar
AM
PM
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
03-Mar
04-Mar
05-Mar
06-Mar
07-Mar
08-Mar
09-Mar
AM
PM
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
23-Feb
24-Feb
25-Feb
26-Feb
27-Feb
28-Feb
01-Mar
AM
PM
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
03-Feb
04-Feb
05-Feb
06-Feb
07-Feb
08-Feb
09-Feb
AM
PM
Date Commencing:
30/12/2024
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
30-Dec
31-Dec
01-Jan
02-Jan
03-Jan
04-Jan
05-Jan
AM
AM
AM
AM - US
PM
PM
PM
PM
PM
PM - CT
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
23-Dec
24-Dec
Christmas
Boxing Day
27-Dec
28-Dec
29-Dec
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
30-Dec
31-Dec
New Year’s Day
02-Jan
03-Jan
04-Jan
05-Jan
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
02-Dec
03-Dec
04-Dec
05-Dec
06-Dec
07-Dec
08-Dec
AM
AM
AM
AM - US
PM
PM
PM
PM
PM - US
PM - CT
Kind regards,
3
Reayrt Noa • Noble’s Hospital • Strang
Braddan • Isle of Man • IM4 4RJ
• www.manxcare.im
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
11-Nov
12-Nov
13-Nov
14-Nov
15-Nov
AM
AM
AM
AM - US
PM
PM
PM
PM - US
PM - CT
Please note PPU administration has had in increase in workload, so we ask if you could please assists by checking
Soliton Manual Status to see if you are scheduled to a PP exam if you have provided availability for that day.
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date
BH
08-July
09-July
10-July
11-July
12-July
13-July
AM
PM
Review Date
Reviewed By
January 2023
January 2024
o
January 2025
Name (Print)
Job Title
e
Date
Signature
l
l
o
r
t
n
o
c
n
U
y
p
o
C
Nobles Isle of Man Hospital
LOCAL RULES FOR RADIATION SAFETY
(The Ionising Radiation Regulations 2017)
Angiography suite
Review Date
n
Reviewed By
Comments
January 2020
o
October 2021
c
October 2022
March 2023
n
June 2024
U
June 2025
June 2026
Nobles Isle of Man Hospital
LOCAL RULES FOR RADIATION SAFETY
(The Ionising Radiation Regulations 2017)
General Rooms including Fluoroscopy and mobiles
Review Date
Reviewed By
Comments
January 2020
p
October 2021
October 2022
o
March 2023
August 2024
C
August 2025
d
Aneurysm Clips (whatever type)
-MUST NOT be scanned unless they have
been proven safe at 1.5 or 3T.
-If the request is for a patient with a non
ferro-magnetic clip in situ the radiologist
must be informed.
-The type and its MR compatibility must be
p
confirmed.
-If the scan is to be performed written
consent accepting responsibility must be
o
obtained from the radiologist or in their
absence the requesting Doctor.
Open heart surgery
C
< than 3 months ago
Female patients that have been sterilized
< than 3 months ago
Coronary stents inserted
< than 8 weeks ago
Occlusive clips or pins inserted
< than 6 weeks ago
Programmable hydrocephalus shunts
d
Cochlear implants
Prosthesis determined not MR safe or not
e
e.g. heart valve replacements
e
e.g. heart valve replacements
determined MR safe
Mechanical, electrical or magnetically
l
l
Unless known to be safe in MRI
operated devices
Metallic splinters in the eye
Unless they have been removed at hospital
o
Any implant not proven to be MR safe
Pregnant patient. Especially those in their
Unless authorised. (See pregnancy rule)
r
first Trimester
t
ECG patches
Unless designed for MRI
Medical skin patches
Unless known to be safe in MRI
n
Mechanical watches
Swipe cards
o
All loose ferro-magnetic objects
All loose ferro-magnetic objects
e.g. money, tools, spectacles, hearing aids,
keys, scissors etc…
c
nFerro-magnetic objects
e.g. monitoring equipment, infusion
pumps, gas cylinders, wheelchairs
and trolleys not marked safe for
MRI etc
U
Cardiac Pacemaker/ICD
Not to be scanned even if known to
be MRI conditional
Level
Limit
Value
Average SAR
t
Absolute Limit
4.0
Average SAR
Discretionary Limit
2.0
n
Peak SAR
Absolute Limit
10.0
Peak SAR
Discretionary Limit
7.5
SAR Aspect
Limits in Normal Operating Mode (W/kg)
Limits in First Level Operating Mode
Whole Body
2.0
4.0
U
Exposed Body
2.0 – 10.0
2.0 – 10.0
Head
3.2
3.2
Uncontrolled Level
Upper Level
Whole-body temperature rise (Degrees C)
d
0.5
1.0
t
Head
Trunk
Limbs
n
Maximum local tissue
temperature (Degrees C)
38
39
40
Duration of exposure
Uncontrolled Level *
Upper Level *
n
>30 mins
1 W kg-1
2Wkg-1
15 - 30 mins
30 W min-1 kg-1
60 W min-1 kg-1
<I5mins
2 W kg-1
4 W kg-1
Peak SARs in any one Kilogram*
Duration of exposure
Read
Trunk
Limbs
>3Omins
2 W kg-1
4 W kg-1
6 W kg-1
15-3Omins
6O W min-1 kg-1
120 W min-1 kg-1
I8O W min-1 kg-1
< l5rnins
4 W kg-1
18 W kg-1
l2 W kg-1
y
p
o
C
d
e
l
l
o
r
t
n
o
c
n
U
Date of Review
Reviewed By
Significant
Comments &
Changes
Section in Policy if
relevant
14.07.2023
E.g. Supervised area
now MR controlled
access area
12.07.2024
No amendments
required.
Policy Title
e
Ultrasound Vetting Guidelines
Author(s)
o
Document effective from
r
June 2023
n
Next review due
t
June 2025
o
Intended audience
c
Sonographers
Radiologists
Any staff member involved in the administration of ultrasound
requests
n
Superseded documents
Vetting guidelines for Ultrasound Examinations (June 2020)
U
Previous reviews
Changes made during
latest review
Vetting
l
o
Triaging process to assess if an ultrasound
r
request is justified and to assess its clinical
urgency
t
n
Justification
Assessment of the clinical information in a
ultrasound request and the subsequent
appropriate use of ultrasound, to answer the
clinical question posed by the referrer
o
c
Qualified Practitioner
Any appropriately trained and registered
healthcare professional such as a Radiographer,
Radiologist or Sonographer
n
Medical referrer
Any medically trained and registered doctor
Non-Medical Referrer
Any non-medically trained and registered health
care professional that has been trained and
approved to request radiological examinations
n
Priority
Definition
o
Urgent
Emergency requests such as ED
cancer referrals (2ww)
carotids (1ww)
Soon
Request that need doing within 4 to
6 weeks
Routine
Not clinically urgent
Referrer Requested
Examinations to be performed as
directed by the referrer, i.e. for a
specific clinic or interval
Cancel
Duplicate request
DUD
Cancel
Not Justified
CNJ
Cancel
Wrong exam requested
p
CNCEXAM
Cancel
Wrong exam, changed to correct exam
CNCEXCH
Cancel
Wrong demographics
o
DEMOG
Reject
C
Inadequate information, please discuss
IR
Reject
Inappropriate requester
IR
Reject
Not justified under current guidelines
NT
Reject
d
Other rejection reason
OTHERJ
Examination
Time frame
y
Requests accepted from
Urgent ED e.g. trauma, sepsis,
?ectopic pregnancy etc.
Same day
p
ED, wards
DVT
Next free allocated slot (11
am and 2pm) as in ED diary
o
ED, wards,
OP if they have same day
follow up
(NOT GP’s)
Carotid
Within 1 week
C
Hospital Consultants only
Cancer referrals on 2ww
pathway
d
Within 2 weeks
GP’s, secondary care
Post-Menopausal Bleeding
(PMB)
e
Within l2 weeks – dates will
be dictated by PIC
PMB pathway –Hospital
Consultant
(NOT GP’s)
Outpatients (secondary care)
l
o
As directed by clinical
rinformation and priority on
request
Secondary care
t
GP’s (primnary care)
As directed by clinical
information and priority on
request
GP’s
o
Referrer requested
As directed by referrer on the
request
GP’s, secondary care
c
n
Private Patients
Within 2 weeks
To be performed out of hours
usually between 8-9 am and
5-6 pm
GP’s Including private GP
practice, Hospital Consultants
General Obstetric requests
As dictated by screening
pathway and/or clinical need
Hospital consultants, some
midwives
Not GP’s
Early Pregnancy Issues
Next available EPAU, or
sooner if clinically indicated
Requests to be generated
through EPAU, or ED if
clinically unstable ?ectopic
Full Response Text
Registered Company No.1941809
www.irs-limited.com
Nobles Hospital – Isle of Man
IRS Annual Report
Report By:
For the Annual Radiation Safety Committee
Meeting Held on the
Wednesday 6th October 2021
REPORT OF THE WORK OF
INTEGRATED RADIOLOGICAL SERVICES LIMITED
FOR
Nobles Hospital – Isle of Man
Reporting Period 1st June 2019 to 31st May 2021
Personal Monitoring
1.1
The doses recorded by hospital employees wearing personal monitoring badges have been reviewed
for the 2019 and 2020 calendar years and compared against dose limits in the Ionising Radiations
Regulations (Application) Order 2019.
1.2
For information, the annual radiation dose limits and dose levels for classification under the IRR17
are as follows:
Whole Body
Extremity
Lens of the Eye
Classified radiation worker
20 mSv
500 mSv
20 mSv
Non-classified worker
15 mSv
150 mSv
15 mSv
Member of public (not patients)
1 mSv
50 mSv
15 mSv
Nuclear Medicine
1.3
members of staff (see below) at Nobles Hospital received a whole body dose in excess of 1.0
mSv, i.e. 1/20th of the annual dose limit during the calendar year. As the IRR17 considers a whole
body effective dose greater than 1 mSv as a ‘significant’ dose the wearers and doses received
are highlighted below. In 2020 the statutory 2 mSv dose investigation level was exceeded and
a local investigation is therefore required.
Wearer No.
Nuclear Medicine
1.42 mSv (2019)
Wearer No.
Nuclear Medicine
2.24 mSv (2020)
1.4
Thermoluminescent dosemeters (TLD) are used to measure extremity doses in the Department of
Nuclear Medicine and Interventional Radiology.
Currently a value of 50 mSv is adopted in Nuclear Medicine as the personal monitoring investigation
level for extremity doses. One members of staff
exceeded the local dose investigation level.
The details are as follows:
Wearer No.
Nuclear Medicine
~58 mSv (2019)
Wearer No.
Nuclear Medicine
~64 mSv (2020)
A local investigation is therefore required. The investigation need not be particularly detailed
if exposures are considered as low as reasonably practicable (ALARP).
Peak finger doses for members of staff in Nuclear Medicine who are preparing, dispensing and
injecting radioactive materials are provided in the table below:
Registered Company No.1941809
www.irs-limited.com
Name
FINGER
Hp 0.07
(mSv)
2016
FINGER
Hp 0.07
(mSv)
2017
FINGER
Hp 0.07
(mSv)
2018
FINGER
Hp 0.07
(mSv)
2019
FINGER
Hp 0.07
(mSv)
2020
Radiology
In 2019, wearers (see details below) recorded unusually high doses compared to typical levels normally
received. The local dose investigation level of 1 mSv was exceeded and a statutory dose investigation was
undertaken by the respective RPSs. The doses were all received in a single monitoring period and would
suggest the exposures were most likely due to an exposure in transit. Landauer have been experiencing
problems with certain carriers subjecting packages to cargo x-ray machines despite being labelled as x-ray
sensitive.
Wearer No.
,
1.69 mSv – received in Q1
Wearer No.
1.21 mSv – receive in Q2
Wearer No.
4.02 mSv – received in Q2
Dose Sharing (IRR17 – Cooperation between employers)
It is noted that several hospital employees carry out limited radiation work at Manx Medical Limited (MML).
Under the regulations, where employees carry out work for another employer, both employers need to
formally cooperate to ensure compliance with the regulations. Typically, this involves sharing of dose
information to ensure dose limits are not exceeded and total levels of exposure are known. The only
noteworthy dose received at MML was as follows:
0.36 mSv (2020).
Total doses aggregated across both sites are below 0.4 mSv and are not significant.
Radiation Safety Surveys & Advice - Ionising Radiations
2.1 Radiation Safety Surveys
A record of all surveys carried out in the reporting period is provided in Appendix 1 of this report. Please note
that the contractual equipment 2 yearly surveys will be taking place week beginning the 6th September 2021.
2.3 Provision of expert advice – RPA/MPE/RWA
The Radiation Protection Adviser (RPA), Medical Physics Expert (MPE) and Radioactive Waste Adviser
(RWA) are available for advice and consultation at any time. A summary of the key consultations and work
items are itemised in full in Appendix 1.
Registered Company No.1941809
www.irs-limited.com
Key headline advisory consultations are listed below:
•
Patient Dose Audit (RPA20-2385)
•
New Plans Consultation for CT and MRI Rooms (RPA20-0986, RPA20-0133 & RPA19-6407)
•
MPE support with the employer’s ARSAC licence application.
•
IRR17 compliance audit report (RPA20-1343)
Patient dose audit and DRLs
The patient dose audit work was concluded in April 2020 using the audit employed methodologies detailed
in Report No. 88 (Institute of Physics and Engineering in Medicine) Guidance on the establishment and use
of diagnostic reference levels for medical x-ray examinations.
Key outcomes from the work are summarised below:
•
Median DAP values compared against previous Local DRLs and National DRLs for radiographic,
fluoroscopic and CT examinations
•
On the whole local doses are deemed acceptable when compared to National DRLs where these
are available
•
The work has identified a small number of examinations where further investigation is required to
assess whether dose reduction is possible. They are:
Radiographic
o Knee AP Examinations median doses were more than 20% higher than the LDRL
o Chest PA Examinations at Ramsey & District Cottage Hospital were 40% higher than the
National DRL.
Radiation Incidents
In the 2-year reporting period, IRS was asked for advice/recommendations following notification of 18
radiation incidents ((8 incidents were reported in 19-20 and 10 incidents were reported in 20-21) involving
exposure to ionising radiation. 15 incidents related to work with x-ray equipment and 3 incidents occurred in
Nuclear Medicine.
All incidents were patient related and therefore considered under IRMER 19 and CQC guidance. For genuine
accidental exposures, where no exposure was intended, the Isle of Man regulation inspectorate have
indicated that all accidental exposures regardless of dose received are to be notified to the Regulation
Directorate. Previously IRS MPEs were using criteria adopted in England for assessment of accidental
exposures. This has consequently led to CT Thorax accidental exposure being retrospectively notified to the
Regulation Directorate.
There were 3 incidents in Nuclear Medicine that were considered reportable due to all patients receiving an
unintended exposure that resulted from the same incident/theme. An equipment malfunction occurred after
3 patient administrations had been injections and it was not possible to scan the patients.
Radiation Safety Surveys & Advice – Non-Ionising
Radiations
Radiation safety surveys and advice are also provided in relation to work with non - ionising radiations
i.e., ultrasound and MRI scanners. These are also listed in Appendix 1.
Only 1 Class 4 laser is currently used in the Eye Clinic. Theatre lasers were decommissioned
Registered Company No.1941809
www.irs-limited.com
Training
The scheduled programme for the forthcoming 12 months is:
•
One Day RPS Refresher Course on 24th November 2021
•
Two Day Radiation Protection Supervisors Course April 2022 TBC
•
One Day Laser Safety Course July 2022 TBC
All courses are currently being run online via MS Teams. For course information please contact
New Regulations and Guidance - IRR17 and IRMER17
No new regulations have been introduced since the last RPC. Since the last RPC there has been up-dated
IR(ME)R guidance in the form of the following publication:
➢ IR(ME)R – Implications for clinical practice in diagnostic imaging, interventional radiology, and
diagnostic nuclear medicine.
https://www.rcr.ac.uk/system/files/publication/field_publication_files/irmer-implications-forclinical-
practice-in-diagnostic-imaging-interventional-radiology-and-nuclear-medicine.pdf
The above report now provides guidance on what constitutes a clinically significant accidental or unintended
exposure (CSAUE). DHSC have not published guidance on this topic but have asked the professional bodies
to provide guidance. CSAUE events will be reportable to CQC in the following circumstances:
•
Accidental or unintended exposure – where the radiation induced cancer risk is greater than
0.1% (1 in 1,000)
•
Foetal risk, where the pregnancy was not known about is greater than 0.1% (1 in 1,000)
•
Unjustified exposure which is greater than 5Gy dose to the skin
Critical Examination Update
IRS has become aware that installers of x-ray equipment are not always honouring their legal obligation to
carry out a critical examination following the replacement or repair of critical safety components that can have
a bearing on radiation safety. Examples of critical safety components requiring a critical examination are new
tube installations and repair or replacement of AEC devices. As the owner of the equipment, we are reminding
employers to seek assurance that limited critical examinations are carried out in these instances and specified
in service and maintenance contracts.
Registered Company No.1941809
www.irs-limited.com
APPENDIX 1
RPA/MPE AND SURVEY WORK UNDERTAKEN FOR NOBLES
HOSPITAL FROM 1st June 2019 to 31st May 2021
RPC REPORT
Period 1 Jun- 2019 to 1 May- 2021
Nobles IOM Trust
IRS
Job Card
Ref
Date Out
Task Code
Contact Name
Contact Type
Date In
RPA WORK COMPLETED ( 97 )
Nobles
Jobs (88)
Breast Screening
RPA20-3590
30-Jun-20
IRMER - QA Programmes (Equipment)
E-mail
25-Jun-20
RPA19-5014
20-Sep-19
Survey - Reports
Report
20-Sep-19
RPA19-3083
24-Jun-19
Survey - Reports
E-mail
17-Jun-19
RPA19-1615
26-Sep-19
IRR17 - Equipment QA Programmes
E-mail
18-Mar-19
Dental Radiology
RPA20-1364
14-Feb-20
Survey - Reports
Report
14-Feb-20
RPA19-5252
15-Oct-19
IRR - Consultation on new plans/installations
Report
01-Oct-19
Laser and IPLs
RPA19-6395
22-Nov-19
Equipment / Source Disposal
Telephone
22-Nov-19
Magnetic Resonance
RPA20-5565
07-Oct-20
Survey - Reports
Report
07-Oct-20
www.irs-limited.com
Registered Company No.194180
06 September 2021
Page 1 of 11
Job Card
Ref
Date Out
Task Code
Contact Name
Contact Type
Date In
RPA WORK COMPLETED ( 97 )
Nobles
Jobs (88)
RPA20-2845
13-May-20
IRR - Consultation on new plans/installations
Other
13-May-20
RPA20-1339
11-Mar-20
Non-ionising - Consultation on new plans / Installations
Report
12-Feb-20
Nuclear Medicine
RPA21-1598
01-Mar-21
IRR - Dose Assessment - Occupational / General Public
Other
01-Mar-21
RPA21-1356
23-Feb-21
IRMER - SAUE Assessment
Report
18-Feb-21
RPA21-1352
23-Feb-21
IRMER - SAUE Assessment
Report
18-Feb-21
RPA21-1354
23-Feb-21
IRMER - SAUE Assessment
Report
18-Feb-21
RPA21-0984
10-Feb-21
IRMER - Employers Licence (ARSAC)
E-mail
05-Feb-21
RPA20-7415
21-Dec-20
IRMER - Employers Licence (ARSAC)
E-mail
21-Dec-20
RPA20-4735
02-Sep-20
IRR - Consultation on new plans/installations
E-mail
26-Aug-20
RPA20-0169
10-Jan-20
IRMER - Policies, Procedures, Clinical Protocols
E-mail
10-Jan-20
RPA19-6920
09-Jan-20
IRMER - Policies, Procedures, Clinical Protocols
E-mail
17-Dec-19
RPA19-6280
18-Nov-19
IRMER - Policies, Procedures, Clinical Protocols
E-mail
18-Nov-19
RPA19-3337
27-Jun-19
IRR - General Consultation
Other
27-Jun-19
Diagnostic Radiology X-Ray
RPA21-1732
04-Mar-21
IRR - General Consultation
E-mail
04-Mar-21
RPA21-1464
25-Feb-21
IRR - General Consultation
E-mail
23-Feb-21
www.irs-limited.com
Registered Company No.194180
06 September 2021
Page 2 of 11
Job Card
Ref
Date Out
Task Code
Contact Name
Contact Type
Date In
RPA WORK COMPLETED ( 97 )
Nobles
Jobs (88)
RPA21-1448
25-Feb-21
IRMER - SAUE Assessment
Report
23-Feb-21
RPA21-0810
01-Feb-21
IRR - General Consultation
E-mail
01-Feb-21
RPA21-0807
01-Feb-21
IRR - General Consultation
Other
01-Feb-21
RPA21-0538
26-Jan-21
IRR - Dose Assessment - Occupational / General Public
E-mail
26-Jan-21
RPA21-0689
26-Jan-21
IRR - General Consultation
E-mail
26-Jan-21
RPA21-0268
18-Jan-21
IRMER - SAUE Assessment
Report
14-Jan-21
RPA21-0131
10-Jan-21
IRMER - SAUE Assessment
E-mail
07-Jan-21
RPA20-7554
07-Jan-21
IRMER - QA Programmes (Equipment)
E-mail
23-Dec-20
RPA20-6647
20-Nov-20
IRR - Advice on monitoring requirements
Other
20-Nov-20
RPA20-6003
12-Nov-20
IRMER - General Consultation
E-mail
28-Oct-20
RPA20-5920
27-Oct-20
IRMER - SAUE Assessment
Report
23-Oct-20
RPA20-5216
28-Sep-20
IRR - Consultation on new plans/installations
E-mail
23-Sep-20
RPA20-4981
10-Sep-20
IRR - Dose Assessment - Occupational / General Public
Report
09-Sep-20
RPA20-4847
03-Sep-20
Non-ionising - Consultation on new plans / Installations
E-mail
03-Sep-20
RPA20-4422
11-Aug-20
Document Preparation
Report
11-Aug-20
RPA20-3925
16-Jul-20
IRMER - General Consultation
E-mail
16-Jul-20
RPA20-3088
29-May-20
Survey - Reports
Report
29-May-20
RPA20-2553
27-Apr-20
IRMER - Patient Dose Audits
E-mail
21-Apr-20
RPA20-2545
20-Apr-20
IRMER - Patient Dose Audits
Report
20-Apr-20
www.irs-limited.com
Registered Company No.194180
06 September 2021
Page 3 of 11
Job Card
Ref
Date Out
Task Code
Contact Name
Contact Type
Date In
RPA WORK COMPLETED ( 97 )
Nobles
Jobs (88)
RPA20-2536
20-Apr-20
Dose Assessment Unintended Patient Exposure
Report
17-Apr-20
RPA20-2385
22-Apr-20
IRMER - Patient Dose Audits
Report
02-Apr-20
RPA20-2057
18-Jun-20
IRR - Consultation on new plans/installations
Report
13-Mar-20
RPA20-1890
09-Mar-20
Dose Assessment Unintended Patient Exposure
Report
09-Mar-20
RPA20-1491
24-Feb-20
IRR - Engineering controls
Telephone
20-Feb-20
RPA20-1390
17-Feb-20
IRR - Consultation on new plans/installations
E-mail
14-Feb-20
RPA20-1343
28-Apr-20
IRR - Compliance Report
Report
12-Feb-20
RPA20-1341
11-Feb-20
External Meeting RPC Attendance
Visit
11-Feb-20
RPA20-1342
11-Feb-20
Compliance Audit Visit, Report
Visit
11-Feb-20
RPA20-1340
11-Feb-20
Site Visit
Visit
11-Feb-20
RPA20-0986
03-Feb-20
IRR - Consultation on new plans/installations
Report
03-Feb-20
RPA20-0236
13-Jan-20
IRR - Consultation on new plans/installations
Telephone
13-Jan-20
RPA20-0183
13-Jan-20
Dose Assessment Unintended Patient Exposure
E-mail
10-Jan-20
RPA20-0157
09-Jan-20
Survey - Reports
Report
09-Jan-20
RPA20-0133
09-Jan-20
IRR - Consultation on new plans/installations
E-mail
08-Jan-20
RPA20-0034
21-Jan-20
IRR - Local Rules and Systems of work
E-mail
02-Jan-20
RPA19-7051
31-D
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